How does Mission: Lifeline respond to the varied interests of competing hospitals and cardiology groups, multiple EMS providers, and access and control of critical care transport or helicopters regarding the STEMI plan?Realizing that all of these entities come to the table with their own agendas, priorities and concerns, Mission: Lifeline seeks to build a consensus around what is best for the patient according to data, guidelines, resources and local leadership.

What are some common perceptions other parties within the STEMI system of care may have regarding STEMI-receiving hospitals that must be overcome in order to build more cohesive partnerships?Emergency medical service (EMS) providers and STEMI-referring hospitals that treat patients who are then transferred to a STEMI-receiving hospital often face a "black hole" experience. Once the patient is out of their care, they are left with questions about outcomes and whether their contributions to treatment helped achieve success. To improve quality of care and recognize the contribution that EMS and STEMI-referring hospitals play in the treatment of STEMI patients, the PCI centers must close this communication gap.

Furthermore, STEMI-referring hospitals may feel that diverting or transferring STEMI patients to PCI-capable hospitals will result in substantial lost revenue. While STEMI victims make up the minority of heart attack patients, this perceived economic threat to non-PCI hospitals must be addressed.

What are some of the progress markers for STEMI-receiving hospitals as they seek to improve their contribution to the STEMI system of care?Mission: Lifeline has defined progress markers for three key areas related to PCI-capable centers, as shown in the table below.

PROGRESS MARKERS

Structure

Median (25th, 75th) arrival time for interventional cardiologist and staff at lab

Percentage of hospitals that have implemented a predefined management plan for emergency coronary bypass surgery (+/-)

Process

Percent of patients eligible for reperfusion who receive it

Percent of patients receiving reperfusion who meet American Heart Association / American College of Cardiology median (25th, 75th) door-to-balloon time

Percent of eligible patients that receive door-to-balloon time of 90 minutes or less or door-to-needle time of 30 minutes or less

Median (25th, 75th) door-to-balloon time and door-to-balloon time of less than 90 minutes as well as median (25th, 75th) door-to-needle time and door-to-needle time of less than 30 minutes for transfer patients

Median (25th, 75th) times patient ischemic time overall and stratified by transfer status

Procedure success: Percent of procedures with angiographic success and no death, MI or emergent/salvage CBG during admission

In-hospital mortality, 30-day risk-adjusted mortality

What are the progress markers for emergency departments (EDs) as they seek to improve their contribution to the STEMI system of care?Mission: Lifeline has defined progress markers for three key areas related to emergency departments, as shown in the table below.